Provider Demographics
NPI:1912437856
Name:ANNIS, MAX MONROE (LAC)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:MONROE
Last Name:ANNIS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BAYARD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4949
Mailing Address - Country:US
Mailing Address - Phone:516-658-7450
Mailing Address - Fax:
Practice Address - Street 1:1069 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4793
Practice Address - Country:US
Practice Address - Phone:862-252-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist